How to manage candiduria

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Candiduria is a frequent finding in clinical practice since Candida spp may be recovered from 1–5% of clean-voided urines in a general hospital. However, many of its diagnostic and therapeutic aspects remain controversial. Its clinical meaning may range from simple bladder colonization to life-threatening disseminated disease, so it must always be carefully evaluated. The kidney is involved in almost 90% of disseminated candida infections and candiduria is an early indicator of dissemination in critically ill patients. Accordingly, patients with confirmed candiduria and risk factors for systemic candidiasis should be identified and unstable patients must receive prompt systemic antifungal treatment. Stable patients must be studied for local or general predisposing conditions, such as obstructive uropathy, genitourinary abnormalities, indwelling bladder catheter or antibiotic therapy. If possible, predisposing conditions should be corrected, and urinary catheters changed. The decision to give antifungal therapy and the selection of local and/or systemic agents will depend on the presence of related symptomatology. Fluconazole is the most frequently used agent. In healthy patients with candiduria it is advisable to obtain a genital specimen for fungal culture. Treatment may not be necessary in this setting.

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